Hydrocephalus | Diagnosis and Treatment

How is hydrocephalus diagnosed?

When a baby is born with hydrocephalus, it doesn’t usually develop until the third trimester of the mother’s pregnancy. Fetal ultrasound is used to diagnose hydrocephalus when a baby is still in the womb.

In infants and older children, hydrocephalus is diagnosed with one or more of the following tests:

intracranial pressure monitoring – this test measures the pressure in a child's skull.

What are the treatments for hydrocephalus?

Hydrocephalus needs to be treated with surgery. There are three options:

Shunt placement — This is the most common treatment for hydrocephalus. During the procedure, a shunt (a thin, flexible tube) is placed in the brain or spinal cord to drain the extra fluid. A one-way valve on the shunt regulates the flow of fluid. Many shunts can also be adjusted externally, using a magnetic device. Shunts need adjustment and replacement over time, and must be checked by a neurosurgeon on an ongoing basis.

Endoscopic third ventriculostomy (ETV) — This surgery may be an option for older children with hydrocephalus, especially for those who have a blocked connection between the third and fourth ventricles of the brain. This is a minimally-invasive procedure that creates an opening in the floor of the third ventricle in the brain, allowing trapped fluid to escape into its normal pathway.

Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) — This procedure can be used as the primary treatment for most infants with hydrocephalus. It combines ETV with CPC, which reduces the tissue in the ventricles (called choroid plexus) that pulsates with every heartbeat, creating pressure waves inside the brains ventricles and also produces some of the cerebrospinal fluid. ETV/CPC is thought to work by reducing the rate of cerebrospinal fluid production and the strength of the pulsations, in addition to providing a new pathway for the fluid to escape. This surgery was pioneered by Benjamin Warf, MD, neurosurgeon at Boston Children's Hospital and director of Neonatal and Congenital Anomaly Neurosurgery.

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